Kidney donors can avoid scars

Chanda Calentine, 30, donated a kidney to her uncle, Scott Bolender, at the Cleveland Clinic, where the belly button procedure was pioneered.

CLEVELAND — Brad Kaster donated a kidney to his father this week, and he barely has a scar to show for it.

The kidney was removed through a single incision in his belly button, a procedure Cleveland Clinic doctors say will reduce recovery time and leave almost no scarring.

Kaster was the 10th donor to have the procedure done at the Cleveland Clinic by Dr. Inderbir Gill and colleagues. The 11th was done Thursday. Gill said the technique could make kidney donations more palatable by sharply reducing recovery time.

"The actual incision point on me is so tiny I'm not getting any pain from it," Kaster, 29, said Wednesday. "I can't even see it."

More than 80,000 Americans are awaiting kidney transplants. Last year, there were about 13,300 kidney donors in the United States, and about 45 percent were living donors, according to the Organ Procurement and Transplantation Network.

The first 10 recipients and donors whose transplants used the single-incision navel procedure have done well, according to the researchers. They report on the first four patients in the August issue of the Journal of Urology.

Preliminary data from the first nine donors who had the belly button procedure showed they recovered in just under a month, while donors who underwent the standard laparoscopic procedure with four to six "key hole" incisions took just longer than three months to recover.

The clinic says the return-to-work time for single-point donors is about 17 days, versus 51 for traditional multi-incision laparoscopic procedure. Patients of the new procedure were on pain pills less than four days on average, compared with 26 days for laparoscopic patients.

"This represents an advance, for the field of surgery in general," said Gill, who predicted that the belly button entry would be used increasingly for major abdominal surgery in a "nearly scar-free" way. "Will this decrease the disincentive to (kidney) donation? I think the answer is yes."

Dr. Paul Curcillo and Dr. Stephanie King of Drexel University College of Medicine in Philadelphia developed a single-incision technique, and Curcillo was the first to use the method to remove a woman's gallbladder through her belly button in May 2007. They've since used it for several types of surgery.

Curcillo said the belly button procedure "will definitely make things better" for the donor. "A donor is one of the most altruistic people you'll ever meet. He's giving his kidney up. So anything you can do to make it better for that patient, they deserve it," he said.

Laparoscopic surgery revolutionized the operating room more than 15 years ago, replacing long incisions with small cuts and vastly reducing pain and recovery time.

Researchers are now exploring ways to eliminate scars by putting instruments through the body's natural openings like the mouth, nose and vagina to perform surgery.

The method is not used to transplant the kidney into the receiving patient.

Dr. Louis Kavoussi, head of the Arthur Smith Institute for Urology of the North Shore Long Island Jewish Health System in New York and the co-author of an editorial in the journal, said the method needs to be studied to determine if patients fare better.

"The reality is that nobody knows if this is an advance other than cosmetic."

How it works

The procedure involves making a three-quarter-inch incision in the belly button and inserting a tube-like port with several entry points for a camera and other tools.

The belly is inflated with carbon dioxide to provide maneuvering room. The kidney is then freed from tissue, wrapped in a plastic bag and removed through the navel when the blood supply is cut, shrinking the organ's fist-like size. The incision is expanded to about 1½ inches to extract the kidney.